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Yamamoto R, Alarhayem A, Muir MT, Jenkins DH, Eastridge BJ, Shapiro ML, Cestero RF. Gaining or wasting time? Influence of time to operating room on mortality after temporary hemostasis using resuscitative endovascular balloon occlusion of the aorta. Am J Surg 2022; 224:125-130. [DOI: 10.1016/j.amjsurg.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 01/24/2022] [Accepted: 03/31/2022] [Indexed: 11/01/2022]
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Savell SC, Blessing A, Shults NM, Mora AG, Medellin KL, Muir MT, Kester N, Maddry JK. Response to Letter to the Editor: The Next Step in Maintaining Peacetime Readiness Level 1 Trauma Centers and OEF/OIF Emergency Departments: Comparison of Trauma Patient Populations. Mil Med 2021; 186:264. [PMID: 34023881 DOI: 10.1093/milmed/usab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shelia C Savell
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA
| | - Alexis Blessing
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Nicole M Shults
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA
| | - Alejandra G Mora
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA
| | - Kimberly L Medellin
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA
| | - Mark T Muir
- Department of Surgery, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Nurani Kester
- Department of Surgery, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Joseph K Maddry
- 59MDW/Science & Technology, USAF En Route Care Research Center, Fort Sam Houston, TX 78234, USA.,Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Savell SC, Blessing A, Shults NM, Mora AG, Medellin KL, Muir MT, Kester N, Maddry JK. Level 1 Trauma Centers and OEF/OIF Emergency Departments: Comparison of Trauma Patient Populations. Mil Med 2020; 185:e1569-e1575. [PMID: 32696959 DOI: 10.1093/milmed/usaa133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Brooke Army Medical Center (BAMC), the largest military hospital and the only level 1 trauma center in the DoD, cares for active duty, retired uniformed services personnel, and beneficiaries. In addition, BAMC works in collaboration with the Southwest Texas Regional Advisory Council (STRAC) and University Hospital (UH), San Antonio's other level 1 trauma center, to provide trauma care to residents of the city and 22 counties in southwest Texas from San Antonio to Mexico (26,000 square mile area). Civilian-military partnerships are shown to benefit the training of military medical personnel; however, to date, there are no published reports specific to military personnel experiences within emergency care. The purpose of the current study was to describe and compare the emergency department trauma patient populations of two level 1 trauma centers in one metropolitan city (BAMC and UH) as well as determine if DoD level 1 trauma cases were representative of patients treated in OEF/OIF emergency department settings. MATERIALS AND METHODS We obtained a nonhuman subjects research determination for de-identified data from the US Air Force 59th Medical Wing and the University of Texas Health Science Center at San Antonio Institutional Review Boards. Data on emergency department patients treated between the years 2015 and 2017 were obtained from the two level 1 trauma centers (BAMC and UH, located in San Antonio, Texas); data included injury descriptors, ICU and hospital days, and department procedures. RESULTS Two-proportion Z-tests indicated that trauma patients were similar across trauma centers on injury type, injury severity, and discharge status; yet trauma patients differed significantly in terms of mechanism of injury and regions of injury. BAMC received significantly greater proportions of patients injured from falls, firearms and with facial and head injuries than UH, which received significantly greater proportion of patients with thorax and abdominal injuries. In addition, a significantly greater proportion of patients spent more than 2 days in the ICU and greater than two total hospital days at BAMC than in UH. In comparison to military emergency departments in combat zones, BAMC had significantly lower rates of blood product administration and endotracheal intubations. CONCLUSIONS The trauma patients treated at a military level 1 trauma center were similar to those treated in the civilian level 1 trauma center in the same city, indicating the effectiveness of the only DoD Level 1 trauma center to provide experience comparable to that provided in civilian trauma centers. However, further research is needed to determine if the exposure rates to specific procedures are adequate to meet predeployment readiness requirements.
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Affiliation(s)
- Shelia C Savell
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234
| | - Alexis Blessing
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234.,Oak Ridge Institute for Science and Education, 100 ORAU Way Oak Ridge, TN 37830
| | - Nicole M Shults
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234
| | - Alejandra G Mora
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234
| | - Kimberly L Medellin
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234
| | - Mark T Muir
- UT Health San Antonio Department of Emergency Medicine, 7703 Floyd Curl Dr. San Antonio, TX 78229
| | - Nurani Kester
- UT Health San Antonio Department of Emergency Medicine, 7703 Floyd Curl Dr. San Antonio, TX 78229
| | - Joseph K Maddry
- USAF En route Care Research Center, 59MDW/Science & Technology, 3698 Chambers Pass JBSA-Fort Sam Houston, TX 78234.,Brooke Army Medical Center Department of Emergency Medicine, 3551 Roger Brooke Dr. JBSA-Fort Sam Houston, TX, 78234
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Yamamoto R, Cestero RF, Muir MT, Jenkins DH, Eastridge BJ, Funabiki T, Sasaki J. Delays in Surgical Intervention and Temporary Hemostasis Using Resuscitative Endovascular Balloon Occlusion of the aorta (REBOA): Influence of Time to Operating Room on Mortality. Am J Surg 2020; 220:1485-1491. [PMID: 32739046 DOI: 10.1016/j.amjsurg.2020.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. METHODS Using the Japan Trauma Databank (2014-2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1-2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. RESULTS Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28-0.65] and 0.42 [0.25-0.71]). CONCLUSIONS REBOA-treated trauma patients who experience delays in surgical intervention (>1 h) have improved survival.
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Affiliation(s)
- Ryo Yamamoto
- Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan; Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Ramon F Cestero
- Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Mark T Muir
- Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Brian J Eastridge
- Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Tomohiro Funabiki
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumiku, Yokohama, Kanagawa, 230-8765, Japan
| | - Junichi Sasaki
- Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Dengler BA, Plaza-Wüthrich S, Chick RC, Muir MT, Bartanusz V. Secondary Overtriage in Patients with Complicated Mild Traumatic Brain Injury: An Observational Study and Socioeconomic Analysis of 1447 Hospitalizations. Neurosurgery 2020; 86:374-382. [PMID: 30953054 DOI: 10.1093/neuros/nyz092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 02/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Secondary overtriage is a problematic phenomenon because it creates unnecessary expense and potentially results in the mismanagement of healthcare resources. The rates of secondary overtriage among patients with complicated mild traumatic brain injury (cmTBI) are unknown. OBJECTIVE To determine the rate of secondary overtriage among patients with cmTBI using the institutional trauma registry. METHODS An observational study using retrospective analysis of 1447 hospitalizations including all consecutive patients with cmTBI between 2004 and 2013. Data on age, sex, race/ethnicity, insurance status, GCS, Injury Severity Score (ISS), Trauma Injury Severity Score, transfer mode, overall length of stay (LOS), LOS within intensive care unit, and total charges were collected and analyzed. RESULTS Overall, the rate of secondary overtriage among patients with cmTBI was 17.2%. These patients tended to be younger (median: 41 vs 60.5 yr; P < .001), have a lower ISS (9 vs 16; P < .001), and were more likely to be discharged home or leave against medical advice. CONCLUSION Our findings provide evidence to the growing body of literature suggesting that not all patients with cmTBI need to be transferred to a tertiary care center. In our study, these transfers ultimately incurred a total cost of $13 294 ($1337 transfer cost) per patient.
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Affiliation(s)
- Bradley A Dengler
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sonia Plaza-Wüthrich
- Division of Spine Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
| | - Mark T Muir
- Department of Surgery, University of Texas Health San Antonio, Texas
| | - Viktor Bartanusz
- Department of Neurosurgery, University of Texas Health San Antonio, Texas
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Abstract
Colon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.
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Affiliation(s)
- Ryo Yamamoto
- Division of Trauma and Emergency Surgery, Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alicia J Logue
- Division of Colon and Rectal Surgery, Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mark T Muir
- Division of Trauma and Emergency Surgery, Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Fowler AL, Hughes DW, Muir MT, VanWert EM, Gamboa CD, Myers JG. Resource Utilization After Snakebite Severity Score Implementation into Treatment Algorithm of Crotaline Bite. J Emerg Med 2017; 53:854-861. [PMID: 29102095 DOI: 10.1016/j.jemermed.2017.08.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/04/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Crotaline envenomation clinical manifestations vary considerably among patients. Current recommendations for treatment with Crotalidae polyvalent immune Fab require assessment of envenomation control. Determining control of envenomation, particularly when patients are evaluated by different providers in separate clinical settings, can be difficult. OBJECTIVE To determine if a difference in total vials of Crotalidae antivenin therapy exists between pre-protocol and post-Snakebite Severity Score (SSS) protocol. METHODS Retrospective medical record review at an academic medical and regional Level I trauma center. Resource utilization in patients with a diagnosis of "snakebite" was compared between patients treated pre- and post-SSS protocol implementation. RESULTS One hundred forty-six patients were included in the evaluation. One hundred twenty-seven (87.0%) patients received antivenin, n = 80 (90.9%) in the pre-protocol group and n = 47 (81.0%) in the post-protocol group. Median total number of antivenin vials per patient was lower in the post-protocol group than the pre-protocol group, 16 (10-24 interquartile range) vs. 12 (10-16 interquartile range), p = 0.006. This decreased utilization correlates to an approximate $13,200 savings per patient. Hospital and intensive care unit length of stay, opioid use, incidence of blood product transfusion, need for surgical intervention, or need for intubation were not different between groups. CONCLUSIONS A snakebite protocol with SSS utilization to guide antivenin administration results in significantly decreased antivenin therapy in snakebite patients without increase in other health care utilization.
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Affiliation(s)
- Amanda L Fowler
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Darrel W Hughes
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Emergency Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mark T Muir
- Department of Trauma and Emergency Surgery, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Elizabeth M VanWert
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, Michigan
| | - Conrado D Gamboa
- Department of Pharmacy, University Health System, San Antonio, Texas; Pharmacotherapy Division, the University of Texas at Austin College of Pharmacy, Austin, Texas; Pharmacotherapy Education and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John G Myers
- Department of Trauma and Emergency Surgery, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Alarhayem AQ, Cohn SM, Muir MT, Myers JG, Fuqua J, Eastridge BJ. Organ Donation, an Unexpected Benefit of Aggressive Resuscitation of Trauma Patients Presenting Dead on Arrival. J Am Coll Surg 2017; 224:926-932. [PMID: 28263857 DOI: 10.1016/j.jamcollsurg.2017.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND We sought to determine whether aggressive resuscitation in trauma patients presenting without vital signs, or "dead on arrival," was futile. We also sought to determine whether organ donation was an unexpected benefit of aggressive resuscitation. STUDY DESIGN We conducted a review of adults presenting to our Level I trauma center with no signs of life (pulse = 0 beats/min; systolic blood pressure = 0 mmHg; and no evidence of neurologic activity, Glasgow Coma Scale score = 3). Primary end point was survival to hospital discharge or major organ donation (ie heart, lung, kidney, liver, or pancreas were harvested). We compared our survival rates with those of the National Trauma Data Bank in 2012. Patient demographics, emergency department vital signs, and outcomes were analyzed. RESULTS Three hundred and forty patients presented with no signs of life to our emergency department after injury (median Injury Severity Score = 40). There were 7 survivors to discharge, but only 5 (1.5%) were functionally independent (4 were victims of penetrating trauma). Of the 333 nonsurvivors, 12 patients (3.6%) donated major organs (16 kidneys, 2 hearts, 4 livers, and 2 lungs). An analysis of the National Trauma Data Bank yielded a comparable survival rate for those presenting dead on arrival, with an overall survival rate of 1.8% (100 of 5,384); 2.3% for blunt trauma and 1.4% for penetrating trauma. CONCLUSIONS Trauma patients presenting dead on arrival rarely (1.5%) achieve functional independence. However, organ donation appears to be an under-recognized outcomes benefit (3.6%) of the resuscitation of injury victims arriving without vital signs.
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Affiliation(s)
- Abdul Q Alarhayem
- University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | | | - Mark T Muir
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John G Myers
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James Fuqua
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Brian J Eastridge
- University of Texas Health Science Center at San Antonio, San Antonio, TX
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Lewis AM, Sordo S, Weireter LJ, Price MA, Cancio L, Jonas RB, Dent DL, Muir MT, Aydelotte JD. Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma. Am Surg 2016; 82:1227-1231. [PMID: 28234189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals' and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.
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Affiliation(s)
- Aaron M Lewis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Lewis AM, Sordo S, Weireter LJ, Price MA, Cancio L, Jonas RB, Dent DL, Muir MT, Aydelotte JD. Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma. Am Surg 2016. [DOI: 10.1177/000313481608201231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.
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Affiliation(s)
- Aaron M. Lewis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Salvador Sordo
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Leonard J. Weireter
- Shock Trauma Center, Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Michelle A. Price
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Leopoldo Cancio
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Rachelle B. Jonas
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L. Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mark T. Muir
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Alarhayem AQ, Liao LF, Stewart RM, Myers JG, Eastridge BJ, Nicholson SE, Muir MT. Management of pediatric splenic injuries: a nationwide analysis. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Muir MT, Inaba K, Ong A, Barmparas G, Branco BC, Zubowicz EA, Salhanick M, Cohn SM. The need for early angiography in patients with penetrating renal injuries. Eur J Trauma Emerg Surg 2011; 38:275-80. [PMID: 26815959 DOI: 10.1007/s00068-011-0155-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 08/25/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Renal injuries occur in as many as 10% of penetrating abdominal wounds. Today, these wounds are often managed selectively, but there is little contemporary information on the natural history of kidney injuries after penetrating trauma. The purpose of this study was to examine the clinical outcomes of penetrating injuries to the kidney, and to determine if these patients may benefit from routine early angiography. METHODS All trauma patients admitted to three Level I Trauma Centers with penetrating renal injuries over a 10 year study period were retrospectively reviewed. RESULTS We identified 237 patients with a penetrating renal injury, of whom 39 died within the first 24 h and were excluded from analysis. Among the remaining 198 individuals, 130 (66%) underwent immediate exploratory laparotomy. Of the 68 subjects not undergoing immediate surgery, seven had early angiography. The remaining 61 patients (31%) were observed, with 12 (20%) ultimately requiring an intervention to treat the renal injury. Those subjects who failed nonoperative management had significantly fewer hospital-free days compared to those who did not need a procedure (19.2 ± 8.1 vs. 25.7 ± 4.5, p = 0.002). CONCLUSIONS Nearly one in three patients with penetrating renal injuries are currently managed with serial observation, although one in five of these subjects ultimately require either angiographic or surgical treatment. We feel that routine use of early angiography may reduce the failure rate and improve outcomes for patients whose penetrating renal injuries are managed nonoperatively.
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Affiliation(s)
- M T Muir
- Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - K Inaba
- Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
| | - A Ong
- Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - G Barmparas
- Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
| | - B C Branco
- Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
| | - E A Zubowicz
- Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - M Salhanick
- Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - S M Cohn
- Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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Muir MT, Cohn SM, Louden C, Kannan TR, Baseman JB. Novel toxin assays implicate Mycoplasma pneumoniae in prolonged ventilator course and hypoxemia. Chest 2010; 139:305-310. [PMID: 20884727 DOI: 10.1378/chest.10-1222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Community-acquired respiratory distress syndrome (CARDS) toxin is a unique Mycoplasma pneumoniae virulence factor. Molecular assays targeting this toxin are more sensitive than existing diagnostics, but these assays have not been used to investigate the role of M pneumoniae as a nosocomial infection in critical illness. We sought to determine the incidence of M pneumoniae among mechanically ventilated subjects using these novel assays and to investigate the impact of this pathogen on pulmonary outcomes. METHODS We conducted a prospective observational study enrolling subjects with suspected ventilator-associated pneumonia (VAP) undergoing BAL in the surgical trauma ICU at a level I trauma center. Lavage fluid and serum samples were tested for M pneumoniae using assays to detect CARDS toxin gene sequences, protein, or antitoxin antibodies. RESULTS We collected samples from 37 subjects, with 41% (15 of 37) testing positive using these assays. The positive and negative groups did not differ significantly in baseline demographic characteristics, including age, sex, injury severity, or number of ventilator days before bronchoscopy. The positive group had significantly fewer ventilator-free days (P = .04) and lower average oxygenation (P = .02). These differences were most pronounced among subjects with ARDS. CONCLUSIONS Evidence is provided that M pneumoniae is present in a substantial number of subjects with suspected VAP. Subjects testing positive experience a significantly longer ventilator course and worse oxygenation compared with subjects testing negative.
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Affiliation(s)
- Mark T Muir
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephen M Cohn
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Christopher Louden
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Thirumalai R Kannan
- Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Joel B Baseman
- Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Abstract
Multiple sclerosis is a chronic disease in which immune cells incite inflammation in the central nervous system, ultimately resulting in the destruction of the myelin nerve sheath. Pathogenic CD4+ T-cells are believed to be responsible for initiating this process. Recent advances in molecular biology, such as transgenic and knockout animal models, genomics and proteomics, have allowed for a much greater understanding of the cellular and subcellular pathways involved in autoimmunity. The end result is an ever more specific array of potential therapeutic agents, each designed to target one component of the dysregulated immune system and in some cases, specific to each individual patient. The mechanisms, promises and pitfalls of these various strategies for the treatment of multiple sclerosis are the topic of this review.
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Affiliation(s)
- Mark T Muir
- University of Texas Southwestern Medical Center at Dallas, Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9036, USA.
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